—— 501(c)(3) Nonprofit Organization ——

Connecticut Epilepsy Advocate Foundation
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Client Authorization

Statement of Authorization

Statement of Authorization

When we take on a new client, they need to sign a Statement of Authorization so we can legally speak on their behalf, and consult with doctors, pharmacists, or anyone whenever it applies.

Below is a sample of what one would look like, naturally each is different for who we represent.

For a copy of the current sample form, please call us at (203) 874-8731.